Regional and Socioeconomic Distribution, Healthcare Utilization, and In-Hospital Mortality of Heart Transplantation

Purpose In 2017, 2817 heart transplants (HT) were performed in the United States, up from 1882 10 years prior. With competing therapies now available, a thorough understanding of the distribution of and resources required for HT is required. Utilizing the National Inpatient Sample (NIS), we examined temporal trends and determinants of short-term outcomes of HT. Methods A retrospective analysis of the NIS from 2001-2011 was performed using SPSS, encompassing N=17426 HT from 2001-2011. Both patient specific and center specific characteristics were characterized with t-test and chi-squared where appropriate. Hospitalizations were grouped according to occurrence before or after the 2006 UNOS allocation policy change. Risk factors were identified using univariate and multivariate analyses. Results Of the N= 17426 HTs included in the analysis, N=6924 and N=10502 occurred 2001-2005 and 2006-2011, respectively. Of these, 76% were male, and 70% were Caucasian, which decreased from 2001 to 2011 (81% v 63%, p<0.0001) demonstrating increased diversity of recipients. Primary insurance was Medicare or Medicaid in 45% and private in 51% of cases. Patients with greater risk underwent HT in 2011 than 2001, having an increased number of comorbidities (3.2±1.7 v 1.0±1.0, p<0.001) and diagnoses (18.4±6.9 v 9.2±3.0, p<0.001). Although longer LoS is correlated with more diagnoses, LoS overall decreased from 2001-2011 (41d v 37d, p=0.0124). Large institutions performed the most HTs (95.8%) with a 9 day shorter LoS than medium sized hospitals (36d v 45d, p=0.001). In-hospital mortality rates decreased from 7% to 5.5% (p=0.077), with the most prominent discharge location being home discharge (53%) followed by home with home healthcare (23%) and skilled nursing facility (8%). Conclusion HT is being performed more frequently in recent years than has occurred previously. Although patients are sicker with additional medical comorbidities and active diagnoses in 2011 than 2001, the average LoS and in-hospital mortality rates are decreasing, likely demonstrating improvement in patient-donor matching and management of HT patients. Elective transplant, hospital region, and teaching status play significant roles in short-term outcomes. In 2017, 2817 heart transplants (HT) were performed in the United States, up from 1882 10 years prior. With competing therapies now available, a thorough understanding of the distribution of and resources required for HT is required. Utilizing the National Inpatient Sample (NIS), we examined temporal trends and determinants of short-term outcomes of HT. A retrospective analysis of the NIS from 2001-2011 was performed using SPSS, encompassing N=17426 HT from 2001-2011. Both patient specific and center specific characteristics were characterized with t-test and chi-squared where appropriate. Hospitalizations were grouped according to occurrence before or after the 2006 UNOS allocation policy change. Risk factors were identified using univariate and multivariate analyses. Of the N= 17426 HTs included in the analysis, N=6924 and N=10502 occurred 2001-2005 and 2006-2011, respectively. Of these, 76% were male, and 70% were Caucasian, which decreased from 2001 to 2011 (81% v 63%, p<0.0001) demonstrating increased diversity of recipients. Primary insurance was Medicare or Medicaid in 45% and private in 51% of cases. Patients with greater risk underwent HT in 2011 than 2001, having an increased number of comorbidities (3.2±1.7 v 1.0±1.0, p<0.001) and diagnoses (18.4±6.9 v 9.2±3.0, p<0.001). Although longer LoS is correlated with more diagnoses, LoS overall decreased from 2001-2011 (41d v 37d, p=0.0124). Large institutions performed the most HTs (95.8%) with a 9 day shorter LoS than medium sized hospitals (36d v 45d, p=0.001). In-hospital mortality rates decreased from 7% to 5.5% (p=0.077), with the most prominent discharge location being home discharge (53%) followed by home with home healthcare (23%) and skilled nursing facility (8%). HT is being performed more frequently in recent years than has occurred previously. Although patients are sicker with additional medical comorbidities and active diagnoses in 2011 than 2001, the average LoS and in-hospital mortality rates are decreasing, likely demonstrating improvement in patient-donor matching and management of HT patients. Elective transplant, hospital region, and teaching status play significant roles in short-term outcomes.